The women who use the morning after pill as everyday contraception

Nursing a nagging headache and a sore throat, Gemma Pickwell queued at the pharmacy counter of her local Boots store on a chilly Saturday morning, her arms laden with cold remedies.

She felt her cheeks flush as she then sheepishly muttered to the pharmacist that she also needed the morning-after pill.

But Gemma's blushes were not simply prompted by the embarrassment of having to ask for such an emergency measure, or the fact that the night before she'd had drunken, unprotected sex with her boyfriend, but also because, shockingly, it was her 60th request for the drug in less than five years.

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Previously only available on prescription from a GP or sexual health clinic, emergency contraception went on sale over the counter at pharmacies across the UK in January 2001.

Since then, concerns have grown about an increasing number of women who are using the morning-after pill as a kind of back-to-front contraception to all but eradicate the risk of pregnancy after they have had unplanned or irresponsible sex.

Certainly, it seems that Gemma is not alone in her habitual use of the drug, though it is hard to believe that many women have been fool-hardy enough to use it quite as many times as her.

The proportion of women obtaining it over the counter rather than from a GP or clinic almost doubled from 27 per cent in 2004 to 50per cent in 2005, with one per cent admitting to using it more than twice a year.

The implication is that Gemma's casual reliance upon Levonelle - the brand name for the morning-after pill - is being selected, even if to a lesser extent, by a growing number of women who see it as an excuse not to practise safe sex in the first place.

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"I'm on the contraceptive pill but I'm just really bad at remembering to take it," shrugs Gemma.

It's a statement that belies the intelligence of this privately educated 26-year-old publishing executive from Surrey who is in a long-distance relationship with 35-year-old Daniel, a property developer from Derbyshire.

Gemma says: "Daniel and I only see each other at weekends so our sex life is highly charged, and I'm not going to abstain just because I've forgotten to take a couple of pills.

"People will say that we could use condoms, but we feel they desensitise sex and make it less intimate, so we'd rather not bother with them and, to be honest, we're often too drunk to have a conversation about contraception in the throes of passion anyway."

It's a cavalier attitude to say the least - some would say idiotic - but Gemma knows there will always be a solution.

"I know that I can just nip to Boots and get the morning-after pill so it's not a problem," she says blithely.

As for her boyfriend, Gemma says he was shocked when she told him how often she uses the morning-after pill, but she adds: 'Only because it's so expensive.' At £25 per dose, to date she has spent £1,500 on the drug.

"Daniel usually buys me lunch as a bit of a trade off whenever I've paid out for Levonelle," she says.

"I literally take it and forget about it and I don't worry about taking it all the time because it says in the leaflet that comes with it that as long as you don't use it more than once in a menstrual cycle then it's fine."

Gemma's relaxed attitude to her sexual health and fertility is not one that's shared by Olga Van den Akker, professor of health psychology at Middlesex University.

"To think that it's healthy to regularly take a drug designed only for emergency use is totally naive.

"The makers of Levonelle may well state that there's no reason why a woman shouldn't take it once every cycle, but on a cautionary note we don't know what the long-term effects of these hormonal preparations are for woman's health and fertility.

"They could well turn out to be nasty.

"How will she feel if, for the sake of expediency, she has been playing Russian roulette with her chances of motherhood?

"In theory, prolonged use of the drug could affect a woman's fertility because it messes about with the body's menstrual cycle," she says.

"These young women who go out, get drunk and regularly have unprotected sex because they rely on the morning-after pill to prevent pregnancy, may one day want to conceive.

"And if they find they can't, then they'll have to deal with the emotional burden of fertility problems brought on by the irresponsible sexual behaviour of their youth."

Levonelle, which is intended to prevent pregnancy in the event of unprotected sex or a split condom, for example, contains high levels of levonorgestrel, a synthetic derivative of the naturally occurring female sex hormone progesterone.

This can prevent ovulation and increase the thickness of the natural mucus at the neck of the womb to make it more difficult for sperm to enter.

Since the whole process, from fertilisation of an egg to implantation in the womb, can take up to three days, the morning-after pill is only certain to work if taken literally the morning after.

Its makers state that it is 95 per cent effective when taken within 24 hours of unprotected sex, 85 per cent between 25 and 48 hours, dropping to just 58 per cent between 49 and 72 hours.

That's why so many women are to be found making a detour to their nearest pharmacy the day after they have had unsafe sex.

Serena Remedios, a 25-year- old martial arts coach from Chippenham, Wiltshire, confesses that, like Gemma, it is her inability to remember to take the contraceptive pill that has led to her using the morning-after pill around 40 times.

"The first time I needed the morningafter pill I was 17 and had my first proper boyfriend.

"I'd gone on the pill but noticed one weekend that I'd missed two pills, panicked because we'd had sex without a condom and made an appointment to get the morning-after pill.

"I was fortunate that taking it didn't make me nauseous as it does with a lot of women."

Did such a scare mean that Serena did not forget to take her contraceptive pills again? Quite the opposite.

Knowing there was the 'safety net' of the morning-after pill, she simply became more and more casual about her own contraception.

"He got increasingly irritated with me and gave me long lectures on being more responsible about remembering to take my pills."

When Levonelle became available over the counter Serena, like countless young women, was aware that she would no longer have to run the gauntlet of her GP to get it.

In fact, she admits, she was happy to spend £25 for each subsequent dose rather than face the uncomfortable prospect of yet another grilling from her doctor.

Serena says: "The truth is that because the morning-after pill was available in pharmacies so readily, there was no real incentive for me to be careful about having safe sex."

Pharmacists, although they have to question each woman to ensure she is suitable to take Levonelle, are not required to keep records of their customers. Small wonder then that the drug is handed out indiscriminately.

Boots spokeswoman Sarah Cameron says their pharmacists can refuse to sell Levonelle and refer a woman back to her GP if they are concerned about why or how often she is using it.

Surprisingly, though, she admits that there is no official guideline on just how many times it is safe for a woman to take the drug.

"Levonelle contains high doses of hormones and isn't licensed for use as a regular contraceptive," she concedes.

"We recommend that it should be restricted to emergencies only and no more than about once or twice a year, though that isn't an official guideline.

"Our pharmacists have strict protocols to follow before agreeing to sell the morning-after pill to a woman, including questioning her on how many times she has used it and when."

The trouble is, of course, that without any kind of medical history to hand, it is the simplest thing in the world for a woman to lie.

Certainly, for young women like Serena and Gemma, who are serial users of Levonelle, the threat of being refused the drug does not work as a deterrent.

They simply make sure they vary the chemists from which they obtain the drug, and are conservative with their answers when quizzed about their personal usage.

As a martial arts coach dependent on possessing optimum health and fitness, does Serena harbour at least some concerns for her health?

"I've never thought about it like that," she says nonchalantly. "And I didn't tell my previous boyfriends that I was taking it, so they were none the wiser.

"I've always had a regular sex life and I've had boyfriends who've been reluctant to use condoms, so I just used to think: 'Oh well, I'll just get the morning-after pill tomorrow.'"

In her early 20s, Serena married Lee, 30, an engineer, and it was he who insisted his wife address her habit of using the morning-after pill as her only contraceptive.

"I'd never been warned about health implications by a doctor or a pharmacist," Serena says disturbingly.

"But Lee was anxious about me missing pills then taking Levonelle to counteract my forgetfulness, so I researched other methods.

"Last year I had the coil fitted and I have to admit that it was a huge relief finally to have a reliable form of contraception that won't fall foul of my dreadful memory."

Ironically enough, it was a failed use of the morning-after pill that changed Angela Nielsen's attitude to her contraception.

A 31-year-old freelance PA from Leicester, she had taken the morning-after pill for the 22nd time when it failed to work and she fell pregnant.

"Last year a condom split when my boyfriend and I were making love. Thirty minutes later we were at the local medical centre so I could get the morning-after pill.

"I wasn't worried because I'd taken it so many times before without really thinking about it.

"But then my period didn't arrive and I started to get strange cramps in my stomach.

"I was stunned when I took a pregnancy test and the result was positive.

"Doctors were alarmed that I'd conceived having taken the morning-after pill so quickly after intercourse, and warned there was a strong chance of an ectopic pregnancy, where the foetus grows outside the womb.

"Two weeks later, I miscarried. It was a dreadful experience and one that's made me very nervous about ever relying on the morning-after pill again.

"I strongly feel that there needs to be much more information available about the downsides of emergency contraception and more transparency about the long-term effects it could have on your health or fertility so that women only take it with extreme caution."

It was a hard lesson for ex-public school girl Angela, who admits she had sex education lessons during her teens which focused on the importance of contraception.

The daughter of an audio engineer father and accountant mother, Angela has a degree in psychology, but confesses she used the morning-after pill more than 20 times in two years with her previous boyfriend.

"I'd been on the contraceptive pill since I was 17 but came off it when I split with a boyfriend after fouranda-half years when I was 25. I thought my body deserved a break after eight years of taking it.

"As a result, I lost 10lb and I felt much happier in myself - I'd often suspected the hormones in the normal contraceptive pill affected my emotional wellbeing.

"When I started dating another guy a year later, I didn't want to go back on the pill and decided against other methods of contraception such as implants because there was a risk of experiencing the same side-effects as with the Pill, such as nausea and mood swings.

"My then boyfriend wasn't keen on the coil as his ex had fallen pregnant despite having one fitted.

"So, we used condoms or the withdrawal method."

She admits, though, that on occasion it was simply irresponsible sex which led her to use the morningafter pill.

"Sometimes, usually when we'd had a drink, we'd throw caution to the wind in the heat of the moment.

"Each time I took the morning-after pill, I suffered with queasiness and a tender, bloated tummy for a few days, which makes me wonder now what else the artificial hormones may have done to my body."

For her part, Angela says that after her pregnancy and miscarriage she and her current boyfriend now take a belt-and-braces approach to contraception, though she admits that but for the unwanted pregnancy, she would doubtless have carried on taking the morning-after pill.

"It got to the stage where we'd be careless during sex and I'd just think: 'Oh well, I'll just tag another hour onto my morning so I can go and get the morning-after pill.'

"I know now that attitude is wrong but so many women think the same and in part it's being driven by the availability of Levonelle.

"Drug companies are making a fortune out of it, so perhaps they aren't telling us the whole story about what it can do to your body if it's taken regularly.

"But there's also an important argument that says making it more readily available is helping reduce the teenage pregnancy rate."

Levonelle spokeswoman Helen Bray believes it's important that women have access to emergency hormonal contraception in order to reduce rates of unplanned pregnancy, but warns that Levonelle should be used in emergencies only and not as a regular method of contraception.

"There is no evidence of detrimental impact on long-term health," she insists, "but Levonelle does not work as well as regular methods of contraception."

As for Gemma Pickwell, she concedes she is likely to find herself queuing up once again in her local chemist sometime soon.

For her perhaps it is just another job to be done to ensure the little matter of pregnancy does not interfere with her life.